Research › Search › Judgment

Rajasthan High Court · body

2025 DIGILAW 626 (RAJ)

Life Insurance Corporation of India v. Bhagwan Lal Jat

2025-03-06

MUNNURI LAXMAN

body2025
JUDGMENT : MUNNURI LAXMAN, J. 1) Heard learned counsel for the petitioner on admission. 2) The challenge in the present writ petition is to the award dated 03.12.2024 passed by the Permanent Lok Adalat, Chittorgarh in Case No.100/2023, whereunder the claim of the respondent for the policy amount was allowed. 3) Challenging the said award, the respondent filed the present writ petition. For convenience, the ranks of the parties as were referred before the Permanent Lok Adalat, are maintained. 4) The sum and substance of the case of the claimant is that the claimant has obtained Children Money Back Plan vide Policy No.106474476 for assured sum of Rs.3 lacs. The policy period covers from 28.09.2015 to 28.09.2038. The premium was required to be paid yearly. There was default of payment of yearly premium resulting in the lapse of the policy w.e.f. 28.09.2020. The policy was revived w.e.f. 01.10.2021 upon submission of Form No.720. The insured has died on 11.09.2022 due to severe headache and mild fever. The deceased suffered physical disability prior to 10.10.2019. As such, a disability certificate was obtained from the Medical Board under Annexure-4. The respondent/ Insurance Company on knowing the suppression of disability of the insured, vide order dated 25.01.2023, the contract of revival was repudiated for suppression of the fact of disability sustained by the insured on the date of revival of the policy and paid Rs.1,66,181/-, the premium amount. 5) The claimant filed a claim petition before the Permanent Lok Adlat, Chittorgarh for the balance amount of the assured sum. 6) The case of the respondent/Insurance Company show that they did not deny the factum of issuance of policy and revival of the policy. Prior to the revival, the father of the insured has submitted a Declaration of Good Health (DGH) Form dated 25.09.2021 (Annexure-3) whereunder he has suppressed the factum of deceased disability, which is clear from the Disability Certificate dated 10.10.2019. The respondent-Insurance Company has repudiated the contract of insurance for suppression of disability sustained by the insured prior to the revival. The fact suppressed was a pre-existing fact, which is material to the contract of insurance. According to the respondent/Insurance Company, the repudiation was done within 3 years from the date of commencement of revival in terms of Section 44(4) of Insurance Act, 1938 (hereinafter referred to as the “Act of 1938”); and they prayed to dismiss the claim. The fact suppressed was a pre-existing fact, which is material to the contract of insurance. According to the respondent/Insurance Company, the repudiation was done within 3 years from the date of commencement of revival in terms of Section 44(4) of Insurance Act, 1938 (hereinafter referred to as the “Act of 1938”); and they prayed to dismiss the claim. 7) The Permanent Lok Adalat after conducting summary proceedings allowed the claim by rejecting the defence set up by the respondent/Insurance Company, by placing reliance on the decisions of Hon’ble Supreme Court in the case of Sulbha Prakash Motegaonkar & Ors. Vs. Life Insurance Corporation of India [Civil Appeal No.8245/2015], decided on 05.10.2015. Aggrieved by the same, the present writ petition has been filed by the respondent-Insurance Company. 8) The main submission of the learned counsel for the Insurance Company is that the Permanent Lok Adlat having found that the claimant suppressed the fact relating to the insured medical condition of suffering disability as is clear from the Disability Certificate dated 10.10.2019, allowed the claim contrary to the provisions contained under Section 45 (4) of the Act of 1938. 9) The learned counsel for the Insurance Company further submitted that any suppression of fact, which is not causative factor for causing of death would also amount to material suppression and the Insurance Company is entitled to repudiate such contract of insurance by placing reliance on Section 45 (4) of the Act of 1938. In support of his contentions, he has relied upon the decisions of Hon’ble Supreme Court in the case of (1) Satwant Kaur Sandhu Vs. New India Assurance Co. Ltd. reported in 2009(5) Supreme 523 , (2) Branch Manager, Bajaj Allianz Life Insurance Co. Ltd. Vs. Dalbir Kaur , reported in (2021) 13 SCC 553 and (3) Sarabjit Kaur & Anr. Vs. L.I.C. of India & Anr. [SLP (C) No.23941/2009], decided on 21.11.2022. 10) In the light of the submissions made by learned counsel for the petitioner, it is apt to refer to Section 45 of Act of 1938, which reads hereunder:- 45. Policy not to be called in question on ground of mis-statement after two years. Vs. L.I.C. of India & Anr. [SLP (C) No.23941/2009], decided on 21.11.2022. 10) In the light of the submissions made by learned counsel for the petitioner, it is apt to refer to Section 45 of Act of 1938, which reads hereunder:- 45. Policy not to be called in question on ground of mis-statement after two years. (1) No policy of life insurance shall be called in question on any ground whatsoever after the expiry of three years from the date of the policy, i.e., from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later. (2) A policy of life insurance may be called in question at any time within three years from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later, on the ground of fraud: Provided that the insurer shall have to communicate in writing to the insured or the legal representatives or nominees or assignees of the insured the grounds and materials on which such decision is based. Explanation I.-For the purposes of this sub-section, the expression "fraud" means any of the following acts committed by the insured or by his agent, with intent to deceive the insurer or to induce the insurer to issue a life insurance policy:- (a)the suggestion, as a fact of that which is not true and which the insured does not believe to be true; (b)the active concealment of a fact by the insured having knowledge or belief of the fact; (c)any other act fitted to deceive; and (d)any such act or omission as the law specially declares to be fraudulent. Explanation II.--Mere silence as to facts likely to affect the assessment of the risk by the insurer is not fraud, unless the circumstances of the case are such that regard being had to them, it is the duty of the insured or his agent keeping silence, to speak, or unless his silence is, in itself, equivalent to speak. Explanation II.--Mere silence as to facts likely to affect the assessment of the risk by the insurer is not fraud, unless the circumstances of the case are such that regard being had to them, it is the duty of the insured or his agent keeping silence, to speak, or unless his silence is, in itself, equivalent to speak. (3)Notwithstanding anything contained in sub-section (2), no insurer shall repudiate a life insurance policy on the ground of fraud if the insured can prove that the misstatement of or suppression of a material fact was true to the best of his knowledge and belief or that there was no deliberate intention to suppress the fact or that such misstatement of or suppression of a material fact are within the knowledge of the insurer: Provided that in case of fraud, the onus of disproving lies upon the beneficiaries, in case the policyholder is not alive. Explanation.--A person who solicits and negotiates a contract of insurance shall be deemed for the purpose of the formation of the contract, to be the agent of the insurer. (4)A policy of life insurance may be called in question at any time within three years from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later, on the ground that any statement of or suppression of a fact material to the expectancy of the life of the insured was incorrectly made in the proposal or other document on the basis of which the policy was issued or revived or rider issued: Provided that the insurer shall have to communicate in writing to the insured or the legal representatives or nominees or assignees of the insured the grounds and materials on which such decision to repudiate the policy of life insurance is based: Provided further that in case of repudiation of the policy on the ground of misstatement or suppression of a material fact, and not on the ground of fraud, the premiums collected on the policy till the date of repudiation shall be paid to the insured or the legal representatives or nominees or assignees of the insured within a period of ninety days from the date of such repudiation. Explanation.--For the purposes of this sub-section, the misstatement of or suppression of fact shall not be considered material unless it has a direct bearing on the risk undertakenby the insurer, the onus is on the insurer to show that had the insurer been aware of the said fact no life insurance policy would have been issued to the insured. (5)Nothing in this section shall prevent the insurer from calling for proof of age at any time if he is entitled to do so, and no policy shall be deemed to be called in question merely because the terms of the policy are adjusted on subsequent proof that the age of the life insured was incorrectly stated in the proposal. (5)Nothing in this section shall prevent the insurer from calling for proof of age at any time if he is entitled to do so, and no policy shall be deemed to be called in question merely because the terms of the policy are adjusted on subsequent proof that the age of the life insured was incorrectly stated in the proposal. "No policy of life insurance effected before the commencement of this Act shall after the expiry of two years from the date of commencement of this Act and no policy of life insurance effected after the coming into force of this Act shall after the expiry of two years from the date on which it was effected, be called in question by an insurer on the ground that a statement made in the proposal for insurance or in any report of a medical officer, or referee, or friend of the insured, or in any other document leading to the issue of the policy, was inaccurate or false, unless the insurer shows that such statement was on a material matter or suppressed facts which it was material to disclose and that it was fraudulently made by the policy-holder and that the policy-holder knew at the time of making it that the statement was false or that it suppressed facts which it was material to disclose: Provided that nothing in this section shall prevent the insurer from calling for proof of age at any time if he is entitled to do so, and no policy shall be deemed to be called in question merely because the terms of the policy are adjusted on subsequent proof that the age of the life insured was incorrectly stated in the proposal." A reading of the above provisions, it is clear that within 3 years from the date of issuance of policy or date of commencement of the risk or the date of revival of policy or the date of rider to the policy, whichever is later, the Insurance Company can call in question policy on any of the grounds whatsoever. However, the insurer is entitled to question the policy within 3 years on the ground of fraud and the same can be done by communicating the insured or the legal representatives or nominees or assignees of the insured the ground and material, on which the decision is taken to repudiate the contract. However, the insurer is entitled to question the policy within 3 years on the ground of fraud and the same can be done by communicating the insured or the legal representatives or nominees or assignees of the insured the ground and material, on which the decision is taken to repudiate the contract. The policy of insurance can also be questioned within 3 years on the ground of any misstatement or suppression of fact material to the expectancy of the life of the insured, which was incorrectly made in the proposal or other document on the basis of which policy was issued or revived and such a decision has to be communicated in writing giving the grounds and material, on which such a decision is taken. If the decision is taken on the ground of misstatement or suppression of material fact and not on the ground of fraud, the premium collected on the policy till the date of repudiation shall be paid to the insured or the legal representative or nominee within 90 days from the date of such repudiation. 11) The repudiation in the present case is done by invoking the provisions under sub-section (4) of Section 45 of the Act of 1938 on the ground of misstatement or suppression of material fact. According to the Insurance Company, the material fact which is suppressed, is existence of disability prior to the revival of the policy. 12) Now, the question for consideration is whether suppression of disability at the time of revival relatable to the cause of death. 13) Admittedly, in the present case, there is no evidence from the Insurance Company to show that the disability sustained by the insured prior to the revival of the policy is causative factor for the death of the insured. The claimant’s case is that the death of the deceased was on account of severe headache and mild fever and not relatable to the disability sustained by the insured. The Insurance Company has come up with the defence that the suppression of disability is the causative factor to the cause of death. No doubt, as per the decision of Hon’ble Apex Court, particularly the decision in the case of Branch Manager, Bajaj Allianz Life Insurance Co. Ltd. (cited supra), every detail sought in the proposal form or any other document is a material fact. No doubt, as per the decision of Hon’ble Apex Court, particularly the decision in the case of Branch Manager, Bajaj Allianz Life Insurance Co. Ltd. (cited supra), every detail sought in the proposal form or any other document is a material fact. Any inaccurate answer will entitle the insurer to repudiate its liability. The decision of the Apex Court in the case of Sulbha Prakash Motegaonkar (cited supra) was also considered and the view taken therein was not overruled. However, it was distinguished and was not made apply to the facts and circumstances existing thereunder. In Sulbha Prakash Motegaonkar’s case, the facts disclosed that there is a suppression of medical condition of pre- existing lumber spondilitis and the death was on account of myocardial infarction, and the Hon’ble Supreme Court found that even though there is a suppression of pre-existing medical condition of lumber spondilitis, the claim was allowed on the ground that such a suppressed medical condition is not a causative factor for causing the death of insured. This means the principle laid down therein was that every suppression of pre- existing medical condition do not result repudiation of contract of insurance unless it is shown that such a suppressed pre-existing medical condition was the causative factor for the cause of death. In the case of Branch Manager, Bajaj Allianz Life Insurance Co. Ltd. (cited supra), the facts disclosed that there is suppression of vomiting of blood, just one month prior to the issuance of the policy and hospitalization as a consequential. In the said background, the Court found that such a suppressed pre-existing medical ailment was the causative factor for the death. In the said background of facts, Hon’ble Supreme Court dismissed the claim. 14) In case of Satwant Kaur Sandhu (cited supra), the facts disclosed that the petitioners suppressed the Chronic Renal Failure/Diabetic Nephropathy and the death was attributable to severe breathlessness resulted cardiac arrest and consequential death. In the said background, the Court held that the suppressed pre-existing medical condition had relation to the cause of death. The facts in hand show that there is no evidence that the death is attributable to the disability sustained by the insured. In the said background, the Court held that the suppressed pre-existing medical condition had relation to the cause of death. The facts in hand show that there is no evidence that the death is attributable to the disability sustained by the insured. 15) In case of Sarabjit Kaur (cited supra), there is a suppression of pre-existing ailment i.e. Hydronephrosis with Hydoureter Left Side, which disease is relating to kidney, which is one of the vital part of the human body. However, the death was on account of brain cancer. In the said decision, Hon’ble Supreme Court has not laid down any ratio except dismissing the SLP agreeing with the stand taken by the National Consumer Disputes Redressal Commission, which has found that there is material suppression though such a suppression of pre-existing medical condition was not a causative factor for the death of the insured therein. The judgment of Sarabjit Kaur (cited supra) as well as the judgment rendered in the case of Sulbha Prakash Motegaonkar (cited supra) was considered by Hon’ble Supreme Court in the case of Branch Manager, Bajaj Allianz Life Insurance Co. Ltd. (cited supra). The ratio laid down by the Apex Court in the case of Sulbha Prakash Motegaonkar (cited supra) stands in the field. 16) The petitioner/non-claimant in the present case failed to establish that the death of the deceased was attributable to any pre-existing medical condition, which is suppressed by the claimant in the Declaration of Good Health (Form No.720). Therefore, the judgment relied upon by the learned counsel for the insurer has no help. 17) The claim of the present respondent-claimant can also be examined in the light of Section 45 (3) of the Act of 1938. A reading of sub-section (3) of Section 45 of the Act of 1938, which is an overriding provision, specifically provides that if there is any misstatement or suppression of a material fact that is within the knowledge of the insurer, the insurer is not entitled to repudiate the contract. In the present case, it is not the case of the Insurance Company that when the policy was issued, they did not see physical presence of the insured. The presumption is that revival of the policy was done basing on the physical verification of the condition of the insured. The disability is a fact which is apparent and visible to the naked eye. The presumption is that revival of the policy was done basing on the physical verification of the condition of the insured. The disability is a fact which is apparent and visible to the naked eye. This means the suppressed fact of pre-existing disability is within the knowledge of the insurer when the revival of the policy was made. The writ petition of the Insurance Company can also be dismissed on this ground alone, in addition to the grounds referred herein-above. In the light of the above findings, this Court is not inclined to interfere in the impugned award. 18) In the result, the writ petition is dismissed in limine. 19) In the circumstances, no order as to costs. 20) Pending interlocutory applications, if any, shall stand disposed of.